The county executives in Rockland and Westchester have both included in their 2011 budgets controversial proposals that would make their governments smaller. In Rockland, County Executive C. Scott Vanderhoef wants to sell the county's nursing home and specialized hospital to a public benefit corporation, a move he says would generate $18 million in new revenue next year. Westchester County Executive Rob Astorino, looking to avoid a tax increase, wants to shutter four county-operated mental health clinics.

Both initiatives have upset affected workers, patient advocates and their patrons in the respective legislatures. Leaders of both legislative bodies have complained that the decisions demand a more thorough exploration than the budget processes allow. The Rockland move is especially ambitious: It took years for some counties pursuing the same course to bring similar sales to fruition. In Westchester, the worry is, the turnaround envisioned by the county executive could be impermissibly disruptive to people receiving services.

While such major changes doubtless would benefit from more extensive vetting than the weeks-long budget process can provide, the ideas behind the moves match trends in government.

Shifting services

Over the last several years, counties across the state have shifted mental health services to nonprofits — which often receive a higher rate of reimbursement from the state and federal government. Rockland moved its alcohol and substance-abuse services to a private provider in 2007, and has been transitioning psychiatric services from the Summit Park facility to Nyack Hospital. This includes a partial-hospitalization program and inpatient psychiatric care.

Mental Health Association of Rockland President/CEO Karen Oates said counties across the country have been scaling back on mental health services as nonprofits have become more specialized and more varied in their offerings. "These decisions look very precipitous, but they've been talked about for years," Oates said.

Astorino's budget plan would shutter four mental health clinics: Peekskill and Mount Kisco facilities would close by Dec. 31 and the Yonkers and Mount Vernon sites would shut by June. The Astorino administration has already notified 1,600 clinic patients of the impending closures, and has sought nonprofits to take over their caseloads. The clinic closures are part of $33 million in spending cuts, including layoffs and cuts to nonprofits and subsidies for health care, proposed by Astorino, a Republican elected on a smaller government platform. His budget would reduce the tax levy by 1 percent.

The pressure is on to close the clinics, Astorino's team has said, because the cost of operating them will skyrocket when lower state reimbursements kick in next year. The county now spends $1.2 million to operate the clinics, but the cost could reach $3.7 million by 2013. That same change in reimbursements is expected to benefit nonprofits that charge a lower rate, according to Astorino aide Ned McCormack. He maintains that the plan does not jeopardize patients, because the county has worked on transition plans with nonprofits, a necessary step to earning state permission to make the move.

The Board of Legislators passed a resolution last week calling on the administration to put off the closure plan until after the budget is finalized, on Dec. 13. "You need to have a transition when you're dealing with a fragile population," Legislator Peter Harckham, D-Katonah, told staff writer Gerald McKinstry. "The key is transition."

Selling an asset

In Rockland, county legislators have expressed frustration that the sale of the nursing home/hospital facility — and the new revenue that the county would derive from it — is tucked into the $711 million budget proposal. They also contend that they don't have the option of taking it out.

"We don't have (the time) to find $17 million or $18 million to plug a hole," Rockland County Legislator Ilan Schoenberger, who leads the Budget and Finance Committee, told the Editorial Board. The county executive unveiled his budget plan Oct. 25 and the Legislature's budget vote is scheduled for Tuesday. Taking out the almost $18 million in revenue the county executive built into the budget from Summit Park's sale would equal a 30 percent tax levy increase on top of the 3.9 percent increase the budget proposal already provides.

The idea of transferring a county-run health-care facility to a public benefit corporation is not rare. Nassau and Westchester have moved their hospitals to public benefit corporations. Ulster County is now studying the future of its county-owned nursing home. Creating a public benefit corporation to run Ulster's Golden Hill Health Care Center is one of many options for the outmoded facility. In Ulster, though, the county Legislature formed a task force last year, which sought proposals for the facility. Last week, the task force reported on nine alternatives for the facility, including a public benefit corporation takeover, which the county will now study further.

County-run facilities like Summit Park, Rockland's nursing home and extended-care hospital, were imperatives decades ago. Nursing homes were less common and assisted-living programs were nonexistent. Vanderhoef has long been an advocate for Summit Park as the safety net for those who cannot afford another option. In fact, before touting the sale of the facility as a budget fixer, Vanderhoef wanted to invest $141 million to build a brand-new facility. The county even obtained state approval in 2008 to do so; Vanderhoef, during his January swearing-in, cited the need for a new state-of-the-art facility to serve Rockland's aging population. Now, he says, a nonprofit center, run by a quasi-governmental organization, can fill the mission of a nursing home serving all comers.

Besides bringing in revenue, the sale of the nursing home would slash personnel costs for the county, including salaries and benefits, because the workers would be employed by the public benefit corporation rather than the county. "That's 700 additional workers who won't be funded by the taxpayer," Vanderhoef told the Editorial Board. One-third of the county's work force is assigned to the nursing home and hospital at Summit Park.

The need to do something dramatic in Rockland is clear: Rockland now has a $38.7 million deficit, and that's likely to grow. Some predict that total could reach $77 million by 2011.

The next step

Both Westchester and Rockland need state buy-ins for their plans. In Rockland, it's far from clear if its public benefit corporation plan will win approval of the state Legislature and Gov.-elect Andrew Cuomo, who has pushed to get rid of similar public authorities. In any case, approval won't come fast; it took six years for Westchester to win approval to convert its medical center to a public benefit corporation.

Nonetheless, Rockland's 2011 budget relies on the nursing home sale as revenue. What happens if the state approval doesn't come through in time for the public benefit corporation to form and issue bonds to make the first payments to Rockland? Schoenberger said that the county could issue "deficiency bonds" that bank on the payment coming later. If it never comes, the county will be stuck with that debt. While other counties have guaranteed their former hospitals' bonds or even continued supporting them financially, Schoenberger said Rockland shouldn't guarantee the debt of a public benefit corporation for Summit Park. "If we're selling the asset, we're selling the asset," he said. "The string will be cut."

Vanderhoef has called the proposed sale an "innovative, bold approach" to downsizing government. His counterpart in Westchester contends his moves are necessary as well — to avoid a tax hike and to reduce the size of a government that has grown too large. The next moves are up to the legislatures in both counties.